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I know noone here is qualified to really give med advice but I've been doing some research on lamictal and most of the sites say that you can start having antidepressant effects at 25-50 mgs but that the mood stabilizing effects dont really hit until you reach 100-200 mgs. I have been on it for 31/2 weeks still on the 50 mgs titrating up. I notice the anxiety/agitation is better and the depression somewhat better. What dosage did you all start to feel a real difference? I know it often takes up to 6 weeks to get a stable dose established.

Cat

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I din't notice a particular effect, as I was put on it just after I started seeing my pdoc and had no depression symptoms. As far as mood stabilizer effects? Anecdotes suggest there is generally not too much in the way of stabilizing. I know I'd be batshit without lithium or something. Of course, for those with lesser swings (say, BPII) it seems to have a better effect that way.

At 6 weeks the normal dose would be...what, 100? Anyways the real defintion I would give to "stable dose" is the one you stop at--by defintion if the dose is changing (i.e. going up) then it can't be stable. The best thing is to go to the usual 200, unless your pdoc wants it otherwise, and watch the moods. You can adjust dosage as needed. I was at 200, started getting depressed, went to 300. No biggie.

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I think it usually works better for people who tend more towards the depressed end of the spectrum, and, yeah, probably for BPII's. Do you know what target dosage your pdoc's got in mind at this point? Lamictal's a really wierd med, while mood stabilization effects usually do kick in, if they're going to, at somewhere around 150-200mg, some people can start noticing them at lower dosages, while others might ultimately find that lamictal's most useful as an antidepressant, and still need another med to keep their moods stable. So I'd say you should pay attention to your moods, and if you find that you're feeling stable at a lower dosage than what you or your pdoc had been thinking of as your target dosage, it's worth thinking about sticking with that dosage, at least for the time being. You can always go up later on, if you need to. By the same token, if you get to that target dosage, and you aren't feeling all that stable, you should keep your pdoc posted, because while a higher dosage might do the trick, if you're feeling less than stable in a hypo/manic kind of way, there's a pretty good chance you'll need to either try augmenting with something like lithium of depakote, or switching to another med altogether.

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Something I forgot to note, but realized while I was thinking about this gal in my office who takes 400mg to my 300: woman often need to take more (double even) to get the same effect. So keep that in mind, if you're not having the desired/expected effect at 200.

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Sometimes women have to take high doses because their birth control reduces the effectiveness of the med, right?

I started noticing an antidepressant effect at 50mg, but I am diagnosed unipolar. I'm not sure when I started noticing mood stabilizing effects but they are definitely there. I don't stay in funks anywhere near as much as I used to and they don't go as deep.

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I can attest to 100mg not being sufficient, that's for sure. It's been about two months for me. Depression is still hanging around and my mood swings are bad during my period (not just PMS, though that's bad, too). Just today, I wigged the hell out and lost my temper. And I thought it was going so well... I guess, when my hormones are just so, my dose is enough to keep me relatively stable, if a little depressed. When I see my pdoc at the end of the month, I'm asking him if I can increase it to 200mg.

My diagnosis is BPI and yet, my pdoc and I agreed that I would try Lamictal first. Is that odd? It sounds like it's atypical. My episodes generally tend toward depressed or mixed; I haven't had a manic episode in years and I think my most recent hypomania was right around the time I met with him for the first time. Maybe the fact that I'm already on Neurontin gave him the idea that the two would work well enough together to control mood swings... or maybe it was because Lamictal was the first med I mentioned when he asked me if I knew what mood stabilizers are.

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I think it usually works better for people who tend more towards the depressed end of the spectrum, and, yeah, probably for BPII's. Do you know what target dosage your pdoc's got in mind at this point? Lamictal's a really wierd med, while mood stabilization effects usually do kick in, if they're going to, at somewhere around 150-200mg, some people can start noticing them at lower dosages, while others might ultimately find that lamictal's most useful as an antidepressant, and still need another med to keep their moods stable. So I'd say you should pay attention to your moods, and if you find that you're feeling stable at a lower dosage than what you or your pdoc had been thinking of as your target dosage, it's worth thinking about sticking with that dosage, at least for the time being. You can always go up later on, if you need to. By the same token, if you get to that target dosage, and you aren't feeling all that stable, you should keep your pdoc posted, because while a higher dosage might do the trick, if you're feeling less than stable in a hypo/manic kind of way, there's a pretty good chance you'll need to either try augmenting with something like lithium of depakote, or switching to another med altogether.

Thank you all for the responses. Since lamictal is the first mood stabilizer I've tried I'm not sure what the pdoc wants me to titrate up to. I suppose whatever dosage can control the symptoms. Right now, I'm still on 50 mgs soon to go to 100 mgs on the starter pack and my next appt is July 25. At that point, she can decide whether or not to taper off the prozac(I'm on 20 mgs) and probably increase me on the lamictal from the 100mgs. This med takes so long to get up to a good level, and I'm trying to be patient but its difficult. I know that I feel less anxious but not sure if thats the prozac, the lamictal or a combo of the two. I have heard that some people take an additional mood stabilzer like lithium or depakote to supplement the lamictal. Is this common?

Cat

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I can attest to 100mg not being sufficient, that's for sure. It's been about two months for me. Depression is still hanging around and my mood swings are bad during my period (not just PMS, though that's bad, too). Just today, I wigged the hell out and lost my temper. And I thought it was going so well... I guess, when my hormones are just so, my dose is enough to keep me relatively stable, if a little depressed. When I see my pdoc at the end of the month, I'm asking him if I can increase it to 200mg.

My diagnosis is BPI and yet, my pdoc and I agreed that I would try Lamictal first. Is that odd? It sounds like it's atypical. My episodes generally tend toward depressed or mixed; I haven't had a manic episode in years and I think my most recent hypomania was right around the time I met with him for the first time. Maybe the fact that I'm already on Neurontin gave him the idea that the two would work well enough together to control mood swings... or maybe it was because Lamictal was the first med I mentioned when he asked me if I knew what mood stabilizers are.

Well I'm kind of in the same boat hormonally speaking. I think I'm having some perimenopausal symptoms which is probably complicating the depression. I plan on seeing my gyno as soon as I get insurance to see what my estrogen levels are. I still lose my temper a lot too but I try not to blow up at people anymore. Just cant wait until I feel halfway normal again.

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Well I'm kind of in the same boat hormonally speaking. I think I'm having some perimenopausal symptoms which is probably complicating the depression. I plan on seeing my gyno as soon as I get insurance to see what my estrogen levels are. I still lose my temper a lot too but I try not to blow up at people anymore. Just cant wait until I feel halfway normal again.

A lot of what I've read about Lamictal says that hormones have an effect on how well it works (but only in women, so testosterone levels in men don't affect it), so that makes sense.

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[quote name='misscat' date='Jul 15 2007, 10:02 AM' post='251026'

Thank you all for the responses. Since lamictal is the first mood stabilizer I've tried I'm not sure what the pdoc wants me to titrate up to. I suppose whatever dosage can control the symptoms. Right now, I'm still on 50 mgs soon to go to 100 mgs on the starter pack and my next appt is July 25. At that point, she can decide whether or not to taper off the prozac(I'm on 20 mgs) and probably increase me on the lamictal from the 100mgs. This med takes so long to get up to a good level, and I'm trying to be patient but its difficult. I know that I feel less anxious but not sure if thats the prozac, the lamictal or a combo of the two. I have heard that some people take an additional mood stabilzer like lithium or depakote to supplement the lamictal. Is this common?

Cat

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The manufacturer says the typical effective dosage is 100 - 200mg but that up to 400mg have been used. We have had at least two CB members who were taking 500mg! I started to notice effects at 50mg, and I leveled at 100mg for 2.5 years. Lamictal is rather subtle and I felt that it took 3 months for it to reach full effect, with slow improvement noticeable each week.

Good luck.

a.m.

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  • 4 weeks later...

I starting at 100mg three years ago without much response. Doc upped it to 200mg and I think I remember feeling better. Even with the addition of other meds though the depression kept creeping in so we upped again to 300mg about 1 1/2 years ago. During my recent hospitalization I was on 425mg and went down to 375mg when I came home. I don't know why I need so much... I'm only 5ft tall and 120ish lbs.

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This is helpful to read. I'm on 300mg; it's been almost exactly three months, titrating 25mg/week (@300 for two weeks now). At 225mg, I had a great, albeit possibly hypomanic, week, followed by a HUGE crash. I'm BPII (plus MDD) with dysphoric hypomanic (irritability) episodes. I never recognized them as such, since my original dx (1988) was chronic MDD and "agitated depression" along with two anxiety disorders.

Ever since I've been aware of the BPII, I've realized I'm one of those ultraradian (sp?) cyclers, not knowing how I'll be hour to hour, though since The Crash (a month ago) I've pretty much been stable at the bottom of the pit. Or maybe it just feels that way in comparison because I had a taste of the "old" me.

I've always been an ultra-rapid metabolizer (when on imipramine, I was on 450mg, which people told me is usually an inpatient dose; Prozac, I had to go to 80mg within a couple of months), and I recently had liver enzymes checked - all normal. So maybe Lamictal didn't crash and burn (which is what I'm really hoping); maybe I need to go up.

I just - now that I've made it through the hellish titration, I really, really want Lamictal to work for me. We added Cymbalta to the mix, and I'm already on 300mg Wellbutrin... so we'll see. But thanks for this thread. Makes me feel better. A little.

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I just - now that I've made it through the hellish titration, I really, really want Lamictal to work for me. We added Cymbalta to the mix, and I'm already on 300mg Wellbutrin... so we'll see. But thanks for this thread. Makes me feel better. A little.

Funny... we're on the exact same meds and dosages. Other than my Lamictal being upped recently and I haven't started Cymbalta. Oh, and other than the Abilify. So I guess we're not on the same meds after all. Duh.

I have an appt tomorrow and was going to ask my doctor about adding Cymbalta since I still have so much depression - and I think it's less likely to cause weight gain, right? I also have hypomanic episodes with lots of irritability and raging at my husband. Poor guy. ;)

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Guest Guest_Chris_*

Well I'm kind of in the same boat hormonally speaking. I think I'm having some perimenopausal symptoms which is probably complicating the depression. I plan on seeing my gyno as soon as I get insurance to see what my estrogen levels are. I still lose my temper a lot too but I try not to blow up at people anymore. Just cant wait until I feel halfway normal again.

A lot of what I've read about Lamictal says that hormones have an effect on how well it works (but only in women, so testosterone levels in men don't affect it), so that makes sense.

Testosterone levels don't affect it at all? As far as you know, at least? I'm a female-to-male transsexual and just started testosterone therapy, and I'm kind of looking around to see how this could affect my meds. (Lamictal, Prozac, Provigil, Xanax). My shrink doesn't have any experience with it, and besides, I haven't had the $ to see him in a couple of months. So far, so good though. Thanks for any input you can give or sites you can point me to....

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Funny... we're on the exact same meds and dosages. Other than my Lamictal being upped recently and I haven't started Cymbalta. Oh, and other than the Abilify. So I guess we're not on the same meds after all. Duh.

LOL - Just chalk it up to Lamictal titration memory issues ;) I'm hoping to keep titrating on Lamictal, if my pdoc thinks it's worth it (seeing her tomorrow). I'm such a rapid metabolizer that I wouldn't be surprised if I'm only getting half the meds in my blood (or brain).

Cymbalta is less likely to cause weight gain, which is part of the reason my pdoc wanted me to try it instead of Effexor (which I wouldn't have to pay for). Unfortunately, the meds are the *only* thing I metabolize rapidly :)

Abilify hasn't come up on my cocktail ingredient radar yet. But it does seem like we're responding similarly.

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I have an appt tomorrow and was going to ask my doctor about adding Cymbalta since I still have so much depression - and I think it's less likely to cause weight gain, right? I also have hypomanic episodes with lots of irritability and raging at my husband. Poor guy. ;)

Have you thought about augmenting with Lithium? It should help with the hypo stuff.

I can't take Lamictal as monotherapy. The pleasant surprise of adding Lithium to control the manicky stuff was that it also noticeably boosts Lamictal's AD effect.

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Have you thought about augmenting with Lithium? It should help with the hypo stuff.

I can't take Lamictal as monotherapy. The pleasant surprise of adding Lithium to control the manicky stuff was that it also noticeably boosts Lamictal's AD effect.

You're right, it probably would help, but I can't take the side effects. I was on Lithium for several years starting in 1996... it was AWFUL. I lost a lot of my hair and what I did have was sparse and course - I remember going to get it cut and the stylist actually cried. Thanks! Way to make me feel even more self-conscious!

It also gave me the shakes so bad I looked like I had Parkinson's. My writing was like an 80-year-old man. Oh, and the nausea. Plus, I sweat a lot (from meds?) and I remember that being a bad thing when you're on Lithium.

Interesting about it boosting Lamintal's effectiveness. Maybe a teeny tiny dose would be all I need. I just don't know if I can bring myself to take it again.

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Have you thought about augmenting with Lithium? It should help with the hypo stuff.

I can't take Lamictal as monotherapy. The pleasant surprise of adding Lithium to control the manicky stuff was that it also noticeably boosts Lamictal's AD effect.

Interesting about it boosting Lamintal's effectiveness. Maybe a teeny tiny dose would be all I need. I just don't know if I can bring myself to take it again.

Kimberly,

I take lamictal and lithium also. I call it a high tolerance to meds but it may be that I'm a fast metabolizer(sp?). I'm actually on 600mg of lamictal which is a high dose. I also take 600mg of lithium. This is a very small amount for me--only .3, very low and not at all in therapeutic range. But I have trouble getting off of it. So you never know if a little lithium would help you out. I haven't had a manic episode since I started this combo (ocassionally a little hypomanic).

Oreo

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Well I'm kind of in the same boat hormonally speaking. I think I'm having some perimenopausal symptoms which is probably complicating the depression. I plan on seeing my gyno as soon as I get insurance to see what my estrogen levels are. I still lose my temper a lot too but I try not to blow up at people anymore. Just cant wait until I feel halfway normal again.

A lot of what I've read about Lamictal says that hormones have an effect on how well it works (but only in women, so testosterone levels in men don't affect it), so that makes sense.

Testosterone levels don't affect it at all? As far as you know, at least? I'm a female-to-male transsexual and just started testosterone therapy, and I'm kind of looking around to see how this could affect my meds. (Lamictal, Prozac, Provigil, Xanax). My shrink doesn't have any experience with it, and besides, I haven't had the $ to see him in a couple of months. So far, so good though. Thanks for any input you can give or sites you can point me to....

OK--so far as I know, the thing with females is that it can take twice the dose of lamictal to get the same effect as a guy does. Whether or not this would hold true for someone taking the kind of hormone doses for a sex change, I dunno, really the only thing is to wait and see. My general idea is that you wouldn't need to raise the lamictal, and could possibly lower it--keeping in mind that "normal" baseline is 200 mg. So if it's working where you're at, don't plan on needing to raise it. Offhand, to be safe, I wouldn't recommend lowering it unless you want to save money--the results may be bad (slip into an icky depression) and you'd have that retitration time too.

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